Portal Angioechography-Its Usefulness in Localizing the Hepatic Tumor

Yasushi Toma

Department of Gastroenterological Surgery, Institute of Gastroenterology, Tokyo Women's Medical College (Director: Prof. Fujio Hanyu)

Portal angioechography, a method of enhancing ultrasonographic images by the injection of carbon dioxide gas into a branch of the portal vein, was used in 31 cases of hepatocellular carcinoma to determine the location of tumors. A 2l-gauge needle for percutaneous transhepatic cholangiography was inserted into an intrahepatic portal branch under ultrasonic guidance. Ultrasonography was performed after the injection of 10-15 ml of CO₂ gas into the branch. Gas was injected into the anterior segmental branch in 26 cases and the posterior segmental branch in 5 cases. The respective areas supplied by these branches became hyperechoic, and borders between them and neighboring areas were clearly recognized, indicating that they were intersegmental borders. In 17 of 18 patients in whom gas was injected into the tumor-bearing segment, the tumors were shown as negative enhancement. In all 31 cases, it was possible to determine whether the tumor was in the anterior segment, posterior segment, or left lobe. In addition, the distance between the tumor and the intersegmental plane was ascertained prior to surgery, which facilitated preoperative planning. The accuracy of these determinations was confirmed at operation. Portal angioechography allows reliable demarcation of hepatic segments and intersegmental planes, and precise location of hepatic tumors.

Key words
portal angioechography, hepatic segment, carbon dioxide gas, hepatocellular carcinoma, localizing hepatic tumors

Reprint requests
Yasushi Toma Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical College
8-1 Kawadacho, Shinjuku, Tokyo, 162 JAPAN

Accepted
June 14, 1993

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